Duplex ultrasound interpretation criteria for inferior mesenteric arteries.

There is no specific duplex ultrasound (DUS) criteria for the diagnosis of inferior mesenteric artery (IMA) stenosis. This study will define the optimal duplex velocity values with the best overall accuracy (OA) in detecting ≥50% stenosis of the IMAs. Eighty-five IMAs with both DUS and mesenteric arteriography were analyzed. Eighty-five IMAs were examined: 45 were normal, 12 with <50% stenosis, eight with ≥50-69% stenosis and 15 with ≥70% stenosis (including occlusion) based on angiography. The mean peak systolic velocities (PSVs) for a normal IMA, <50% and ≥50% stenosis was 105, 215 and 392 cm/second, respectively (P < 0.0001). The most accurate PSV in detecting ≥50% stenosis was ≥250 cm/second with a sensitivity of 90%, a specificity of 96% and an OA of 95%. The most accurate end-diastolic velocity (EDV) in detecting ≥50% stenosis was ≥80% or ≥90 cm/second, with an OA of 86%, a sensitivity of 60% and a specificity of 100%. The most accurate ratio in detecting ≥50% stenosis was ≥4 or ≥4.5 with an OA of 93%.Receiver operator curves analysis showed that the PSV was not better than EDV and PSV ratio in detecting ≥50% stenosis (P = 0.1661 and 0.4568, respectively). In conclusion, specific IMA PSVs, EDVs and IMA/aortic systolic ratios can be used in detecting significant IMA stenosis with reasonable accuracy.

Early and late clinical outcomes of endovascular aneurysm repair in patients with an angulated neck.

This study analyzed the clinical outcome in endovascular aneurysm repair (EVAR) patients with an angulated aortic neck. Two hundred thirty-eight EVAR patients underwent postoperative duplex ultrasonography and/or computed tomographic angiography, which was repeated every 6 to 12 months. Aortic neck angle was classified into < 45 degrees (A1, n= 129), > or = 45 to < 60 degrees (A2, n = 43), and > or = 60 degrees (A3, n = 42). The perioperative complication rates for groups A1, A2, and A3 were 13%, 5%, and 29%, respectively (p = .006). Proximal type I early endoleaks occurred in 9%, 33%, and 38% in groups A1, A2, and A3, respectively (p < .0001). Intraoperative proximal aortic cuffs were needed in 7%, 28%, and 33% in groups A1, A2, and A3, respectively (p < .0001). However, the rate of late reintervention was comparable in all groups. Postoperatively, the size of abdominal aortic aneurysm decreased or remained unchanged in 97%, 95%, and 84% in A1, A2, and A3, respectively (p = .0147). The rates of freedom from late type I endoleak at 1, 2, and 3 years were 90%, 85%, and 85% for A1; 74%, 74%, and 68% for A2; and 64%, 64%, and 53% for A3 (p = .0013). EVAR can be used for patients with an angulated aortic neck but was associated with a higher rate of early and late type I endoleaks and early interventions.

Angioplasty and stenting versus carotid-subclavian bypass for the treatment of isolated subclavian artery disease.

PURPOSE: To compare the results of a large series of percutaneous transluminal angioplasty (PTA)/stenting procedures in the subclavian artery with the results of a series of carotid-subclavian bypass grafts (CSBG) performed at the same institution for subclavian artery disease. METHODS: Between 1993 and 2006, 121 patients (43 men; mean age 63 years, range 38-85) underwent subclavian artery PTA/stenting and were compared to a group of 51 patients (29 men; mean age 62 years, range 46-75) with isolated subclavian artery occlusive disease treated with CSBG using polytetrafluoroethylene grafts. Graft or PTA/stenting patency was determined clinically and confirmed by Doppler pressures and/or duplex ultrasound/angiography. The cumulative patency and overall survival rates were calculated using the life-table method. RESULTS: The mean follow-up for the PTA/stent group was 3.4 years versus 7.7 years for the CSBG group. The technical success rate for the CSBG group was 100% versus 98% (119/121) for the PTA/stent group. The overall perioperative complication rate in the stent group was 15.1% (18/119: 11 minor and 7 major complications) versus 5.9% (3/51: 2 phrenic nerve palsy and 1 myocardial infarction) in the bypass group (p=0.093). There was no perioperative stroke or mortality in the CSBG group. The major perioperative complications in the stent group included 4 thromboembolic events, 1 congestive heart failure, 1 reperfusion arm edema, and 1 pseudoaneurysm. There was 1 perioperative death in the stent group. The 30-day patency rate was 100% for the bypass group and 97% (118/121) for the PTA/stent group. The primary patency rates at 1, 3, and 5 years were 100%, 98%, and 96% for the CSBG group versus 93%, 78%, and 70% for the stent group, respectively (p<0.0001). Freedom from symptom recurrence was also statistically superior in the bypass group versus the stent group (p<0.0001). There were no significant differences in the survival rates between both groups at any time point (p=0.322). CONCLUSION: Both CSBGs using PTFE grafts and subclavian PTA/stenting are safe, effective, and durable; however, CSBG is more durable in the long term. PTA/stenting of the subclavian artery should be the procedure of choice for high-risk patients; however, CSBG should be offered to good-risk surgical candidates who may be seeking a more durable procedure.